tbuckley/cabot-search huggingface dataset:
Real-world healthcare costs amongst non-small cell lung cancer (NSCLC) patients tested with a host immune classifier (HIC).
Authors: Wade Thomas Iams, Kimberly Le, Nicole Princic, Taylor Marlin
Journal: Journal of Clinical Oncology (2023)

e21187 Background: The HIC is a proteomic test that measures immune response in patients diagnosed with NSCLC. The blood based HIC stratifies patients into two groups, HIC-H and HIC-C which helps evaluate the patient’s prognosis and response to treatment. Currently, no real-world studies have described healthcare costs amongst patients tested with the HIC. This subset analysis of HIC claims examined costs among patients with NSCLC prior to and after using the HIC proteomic test. Methods: HIC test results were retrospectively queried using MarketScan Commercial and Medicare Supplemental Databases using data between January 1, 2016 to June 30, 2021 linked to Biodesix data files. Patients were included if they were age 18 and older on index date (date of HIC testing), underwent a HIC proteomic test, were continuously enrolled in the MarketScan database for the 6-months before index (pre-index period) and one month post-index, and had at least one non-diagnostic medical claim of lung cancer during the pre-index period. Healthcare costs were measured per patient per month (PPPM) during the pre-index and post-index period and compared between HIC-H and HIC-C cohorts. All-cause healthcare costs analyzed included inpatient costs, outpatient costs, outpatient pharmacy costs, total medical costs (inpatient + outpatient), and total costs (total medical + outpatient pharmacy). Results: Of the 328 included patients, 260 patients were HIC-H and 68 were HIC-C. On index, 178 patients had non-metastatic lung cancer and 150 patients had metastatic lung cancer. When examining healthcare costs prior to HIC testing, total costs and inpatient costs were higher amongst HIC-C patients ($10,299 vs $9,689 and $4,032 vs $3,218, respectively) although not statistically significant. HIC-C patients had significantly higher biopsy costs compared to HIC-H patients ($1,285 vs $400, P &lt; 0.05) even though less HIC-C patients underwent a lung biopsy (41% vs 53%, P = 0.091). When assessing healthcare costs post HIC testing, total medical costs were significantly higher in the HIC-C patients ($25,255 vs $17,210, P &lt; 0.05). Although not statistically significant, HIC-C patients had higher inpatient costs and total costs ($9,903 vs $5,583 and $26,237 vs $18,652, respectively). Amongst the patients had significantly higher inpatient costs ($18,580 vs $4,278, P &lt; 0.05), total medical costs ($29,574 vs $12,446, P &lt; 0.05) and total costs ($31,316 vs $13,500, P &lt; 0.05). Conclusions: Patients with NSCLC who are identified as HIC-C have higher healthcare costs, including lung cancer diagnostic and total costs, prior to and post HIC testing. Utilization of the HIC test may help to identify patients who may benefit from additional health system navigation support to mitigate their anticipated increased health care costs.
Outcome of immune checkpoint inhibitors in patients with extensive-stage small-cell lung cancer and brain metastases.
Authors: Chunyu Wang, Fangfang Jing, Fan Zhang, Haitao Tao, Junxun Ma, Yi Hu, Lijie Wang
Journal: Journal of Clinical Oncology (2023)

e20625 Background: Brain metastases (BMs) are common in extensive-stage small-cell lung cancer (SCLC) and are underrepresented in pivotal clinical trials that demonstrate the efficacy of immune checkpoint inhibitors (ICIs). We conducted a retrospective analysis to assess the role of ICIs in BM lesions in less selected patients. Methods: Patients with histologically confirmed extensive-stage SCLC who were treated with ICIs were included in this study. Objective response rates (ORRs) were compared between the with-BM and without-BM groups. Kaplan‒Meier analysis and the log-rank test were used to evaluate and compare progression-free survival (PFS). The intracranial progression rate was estimated using the Fine-Gray competing risks model. Results: A total of 133 patients were included, 45 of whom started ICI treatment with BMs. In the whole cohort, the overall ORR was not significantly different for patients with and without BMs (p = 0.856). The median progression-free survival for patients with and without BMs was 6.43 months (95% CI: 4.70-8.17) and 4.37 months (95% CI: 3.71-5.04), respectively (p = 0.054). In multivariate analysis, BM status was not associated with poorer PFS (p = 0.101). Our data showed that different failure patterns occurred between groups, with 7 patients (8.0%) without BM and 7 patients (15.6%) with BM having intracranial-only failure as the first site progression. The cumulative incidences of brain metastases at 6 and 12 months were 15.0% and 32.9% in the without-BM group and 46.2% and 59.0% in the BM group, respectively (Gray’s p &lt; 0.0001). Conclusions: Although patients with BMs had a higher intracranial progression rate than patients without BMs, the presence of BMs was not significantly associated with a poorer ORR and PFS with ICI treatment in multivariate analysis.
Clinical benefit (rate) of geriatric assessment in a Veterans Affairs (VA)-based oncology clinic according to the Geriatric 5Ms framework.
Authors: Dave Gregorio, Sarah Shaker, Becky Powers, Sukeshi Patel Arora, Ranjit Singh Banwait, Paromita Datta
Journal: Journal of Clinical Oncology (2023)

e24010 Background: The geriatric assessment (GA) is a validated, multi-system assessment tool that can detect vulnerabilities often not captured with standard oncology assessments in older adult patients with cancer. The Geriatric 5Ms is a novel communication framework used to describe core competencies in geriatrics. Prior studies have shown GA integration in oncology practice can significantly reduce grade 3 or higher chemotherapy-related toxicities, falls, polypharmacy, hospital length of stay (LOS), increase completion of advanced directives, and improve quality of life measures. Despite these benefits, implementation into clinical practice has remained low. This study aimed to utilize telemedicine to integrate GA into a busy VA oncology practice. Methods: In this quality improvement study design, we enrolled adult patients aged 70 years and older with solid tumors or hematologic malignancy, either newly established or receiving active systemic treatment through an urban, academic VA oncology clinic. Patients were assigned to the intervention (GA conducted via telemedicine by a geriatric specialist) if they scored ≤14 on G8, a validated screening tool. Outcomes were compared with a historical control cohort who received usual care (no virtual GA). Reported here are the clinical benefits measured qualitatively according to the geriatric 5Ms framework. Results: Between January 1, 2022 and March 30, 2022, we enrolled 116 patients (n = 57 intervention, 59 control) from a US VA-based population. Patients had a mean age of 76.8 (SD 6.2) between both cohorts and all patients were male (100%). Among patients in the intervention cohort, all patients (100%) derived benefit in at least one element of the 5M’s framework (Mind, Mobility, Medications, Multicomplexity, and Matters Most) from GA. Based on findings from the GA, services were provided in each of the 5M’s categories in the following frequencies: multicomplexity (88%), matters most (71%), medication (58%), mentation (50%), and mobility (46%). Conclusions: Incorporating GA via telemedicine into routine oncologic care was feasible within this VA-based population of older adult patients with cancer. Further, this project led to clinic recognition as an Age Friendly Health System by the Institute for Healthcare Improvement (IHI). When routinely performed, geriatric assessment led to clinical benefit among all patients receiving the intervention according to the 5M’s framework. Future studies will compare the clinical benefits of this intervention to clinical outcomes measures such as hospital length of stay, emergency room utilization, therapy toxicity, and survival among this patient population.
Is Karnofsky performance scale a proxy measure of frailty phenotype in older adults with cancer?
Authors: Armida Parala-Metz, Wael Lasheen, Daniel Ernest Haggstrom, Raghava Reddy Induru, Anthony James Caprio, Declan Walsh
Journal: Journal of Clinical Oncology (2023)

e24035 Background: The use of performance status (PS) assessments in patients with cancer is a common practice to determine their suitability for treatment, clinical trial enrollment, and prognosis. The Karnofsky Performance Scale (KPS) and Eastern Cooperative Oncology Group Performance Status (ECOG PS) score are widely used clinical instruments for this purpose. However, these tools are subjective and unidimensional, with potential for bias, and were validated in younger patients. KPS has demonstrated greater specificity than ECOG in evaluating PS. Frailty, a dynamic medical syndrome characterized by diminished strength, endurance, and reduced physiological function, is recognized as a predictor of vulnerability to adverse outcomes, especially in older adults with cancer. The Fried Frailty Phenotype (FP) is a widely validated tool that uses both objective and subjective measures to identify frailty based on presence of 3 or more criteria: unintentional weight loss, self-report of exhaustion (fatigue), weakness (measured by grip strength), slow walking speed, and low physical activity. Our study compares physician-rated KPS with FP (fit, prefrail, frail) and looks at correlation of both tools in older adults with cancer. Methods: Data from older adults with solid tumor malignancies referred to the geriatric oncology clinic for geriatric assessment (GA) from January 2015–August 2019 were abstracted. Physician-rated KPS (0-100) were categorized into 3 groups: normal activity, high functioning (80–100); intermediate, capable of self-care but unable to do active work (70); and poor PS, requires considerable assistance (&lt;60). These were compared to FP which classified patients based on the number of frailty criteria present: fit (0), prefrail (1-2), and frail (&gt;3). Frequency data calculation and bivariate analysis were done. Results: 241 older adults with cancer completed a GA, median age of 80 years, 52% female. 57% were frail, 37% prefrail, and 6% fit. 90% of patients with KPS 80-100, had prefrail and frail phenotypes. Patients with KPS 70 had 24% prefrail and 76% frail phenotypes and those with KPS &lt; 60 had 10% prefrail and 90% frail phenotypes. Conclusions: Majority of older patients with prefrail and frail phenotypes were assessed as high functioning (KPS 80-100). KPS is an inadequate substitute for FP and should not be used alone in assessing functional status of older adults with cancer.
Clinical features and outcomes of pediatric nasopharyngeal carcinoma: A SEER database study.
Authors: Garima Nirmal, Adnan Ali, Neha Gupta, Dinesh Pendharkar
Journal: Journal of Clinical Oncology (2023)

e22011 Background: Nasopharyngeal carcinoma (NPC) is a rare malignant tumor. Little is known about the clinical, histological and survival characteristics of this disease in pediatric patients. Methods: We searched 17 registries of the surveillance, epidemiology, and end results (SEER) database for pediatric patients (£20 years old) with NPC who were diagnosed between 2000 to 2019. Data obtained included the demographics, histological subtype, stage, median household income, place of residence, cause specific survival (CSS) and overall survival (OS). We describe the clinical features and survival outcomes by race of pediatric patients. Results: A total of 373 primary pediatric NPC patients were reported between 2000-2019. Median age of diagnosis was 16 years (inter-quartile range 11.5 – 19 years). Of these, 68% were males, 59% were white and 27% were black. Undifferentiated non-keratinizing carcinoma group (WHO type III) was the most frequent (70%) histological sub-type. WHO type I and II disease was found to be present in 12% and 18% cases respectively. Nearly, 4 in 5 patients (83%) had stage III – IV NPC at presentation. Stage I and II disease at presentation was found to be present in 5% and 12% of NPC patients respectively. The median follow-up was 10.1 years. The 5 and 10 year survival estimates were 83% (95% CI 78.8% to 86.9%) and 79% (95% CI 73.9% to 83.1%) respectively. On multivariate Cox regression analysis, gender (Male vs Female: HR: 1.00, 95% CI 0.39-2.57; p = 0.998) and race (White vs Black: HR: 0.81 95% CI 0.311-2.10; p = 0.663) were not found to be significant predictors of survival. Conclusions: Pediatric patients at presentation with NPC were more commonly male, had undifferentiated non-keratinizing carcinoma (WHO type III) and stage III-IV disease. Gender and race were not found to be associated with an increased risk for mortality in pediatric patients presenting with NPC.
Genomic profiling of cerebrospinal fluid ctDNA to characterize molecular features and monitor intracranial responses of patients with osimertinib-resistant non-small cell lung cancer with leptomeningeal metastases.
Authors: Yichun Hua, Ying Xin, Xiaosheng Ding, Juan An, Xixi Zheng, Lili Zhou, Hui Shi, Weiran Xu, Fang Wei, Qichao Wu, Yubin Li, Feilong Zhao, Depei Huang, Xiaoyan Li
Journal: Journal of Clinical Oncology (2023)

e21095 Background: Leptomeningeal metastasis (LM) indicates an unfavorable prognosis in non-small cell lung cancer (NSCLC). Due to the blood-brain barrier, plasma is not an ideal medium to evaluate osimertinib resistance mechanisms in patients with LM. This study aimed to use cerebrospinal fluid (CSF) as a source of ctDNA for characterizing molecular features and monitoring intracranial responses from patients with leptomeningeal metastases who progressed on osimertinib. Methods: From Jan 2020 to Nov 2022, 65 patients with advanced NSCLC, including 32 osimertinib-treated patients, 6 other TKI-treated patients, and 27 treatment-naïve patients, in Beijing Tiantan Hospital were enrolled in this study. CSF obtained via lumbar puncture was used for targeted sequencing and cytologic analysis. In parallel, paired plasma from 35 patients was also subjected to targeted sequencing. Results: Among 65 patients, the overall positive rate of CSF ctDNA was 77% (50/65), 94% (34/36) in patients with LM, and 55% (16/29) in patients with brain parenchymal metastases (p = 0.0002). CSF ctDNA analysis had a higher consistency with the cytologic diagnosis of LM than imaging. Among the patients cytologic diagnosed with LM, 94% (32/34) of the patients had positive CSF ctDNA analysis at the same time, while the positive diagnostic rate of imaging was only 39% (13/33). EGFR alteration was found in 97% (29/30) CSF of patients with LM who progressed on Osimertinib, including L858R (67%), exon19 deletion (17%), T790M (10%), L861Q (7%), G719X (7%) and L747X (7%). Other recurrent genes discovered in the CSF were TP53 (73%), PIK3CA (43%), ERBB2 (33%), POLE (33%), ALK (27%), BRCA2 (27%), BRAF (23%), BRCA1 (23%), RB1 (20%) and PALB (20%). In the 35 paired CSF-plasma pairs, more alterations were uniquely found in CSF than in plasma (71% vs 17%), and only 12% of alterations were shared. Serial surveillance of CSF ctDNA in 7 cases of LM patients treated with osimertinib found that the VAF of CSF ctDNA showed a highly consistent trend with the tumor cell fraction of cytology. Conclusions: For NSCLC patients with LM, liquid biopsy of CSF is more sensitive than plasma to characterize osimertinib-resistant mechanisms and guide follow-up treatment. Serial surveillance of CSF ctDNA dynamics may reflect the intracranial tumor responses, which still needs to be validated in a large sample size.
Representativeness in cancer treatment trials in community and academic settings.
Authors: Ivy Altomare, Xiaoliang Wang, Sam Falk, Maneet Kaur, Jenny Guadamuz, Forrest Xiao, Neal J. Meropol, Yihua Zhao
Journal: Journal of Clinical Oncology (2023)

e18550 Background: Patients with cancer who participate in clinical trials may not be representative of the broader patient population, which can impact the generalizability of results. However, it is unknown whether practice setting influences representativeness of trial participants. Here we evaluated (1) whether demographic characteristics of patients enrolled in cancer treatment trials at academic sites differ from those in the community and (2) the degree to which trial patient characteristics are representative of the overall patient population seen in each practice setting. Methods: This retrospective study used the nationwide Flatiron Health electronic health record-derived de-identified database, originating from ~280 US cancer clinics (~800 sites of care). We included patients with a cancer diagnosis and clinical visits between 11/1/17 - 11/1/22. Clinical study drug administration was used as a proxy for trial participation. We applied multivariate logistic regression to assess the association of age, sex, race/ethnicity, insurance status and neighborhood socioeconomic status [SES] quintile with practice setting among trial participants, and Pearson 𝛘2 test for independence to assess the association between distribution of patient characteristics in trial participants versus trial non-participants. Results: Of 28,235 trial participants, 13,297 (47%) were treated at academic and 14,938 (53%) at community sites. Among patients who participated in clinical trials, the odds of enrollment at a community versus academic site were significantly higher among patients who were older (75+ odds ratio [OR] 1.91, 95% confidence interval [CI] 1.73-2.11), Female (OR 1.22, CI 1.14-1.31), Black (OR 1.32, CI 1.16-1.50), had Medicaid (OR 1.22, CI 1.07-1.39 ) or were uninsured/unknown (OR 2.05, CI 1.82-2.31) and had the lowest quintile SES (OR 1.78, CI 1.58-2.00), and were significantly lower among patients who were Latinx (OR 0.56, CI 0.48-0.65) or higher ECOG Performance Status (2+ OR 0.75, CI 0.65-0.87). Significant differences in each patient characteristic category existed between trial participants and trial non-participants at both academic and community sites (p &lt; 0.001). Trial participants and trial non-participants were more similar (𝛘2 values less discordant) in sex and race/ethnicity at academic sites, and more similar in insurance and SES categories in the community. Conclusions: When compared to academic centers, community sites had proportionately greater enrollment of older, Black, Medicaid/uninsured and low SES patients. Significant differences existed between trial participants and trial non-participants in both settings for each demographic category. These findings highlight how community site involvement may improve trial representativeness, and underscores the need for targeted solutions to optimize trial representativeness in both academic and community practices.
Health disparities among patients with Ewing sarcoma in Florida.
Authors: Dan Kim Pham, Rachna Rahul, Rachel Kronenfeld, Tulay Koru-Sengul, Paulo S. Pinheiro, Aditi Dhir
Journal: Journal of Clinical Oncology (2023)

e18549 Background: Ewing sarcoma (ES) is the second most common malignant bone tumor in children and young adults. Although usually localized, subclinical metastatic disease is often present. Treatment includes multi-agent chemotherapy with surgery or radiation for local control. Though overall survival (OS) has improved to 70% for localized disease, mortality from recurrent or metastatic disease remains high. Although, ES is most common among Non-Hispanic White adolescent males, prior population-based ES studies utilizing Surveillance, Epidemiology, and End Results (SEER) have shown increased mortality among White Hispanics, Blacks, and those of low socioeconomic status (SES). Florida is not part of SEER but is home to a unique population with high proportions of immigrants and Hispanics of distinct backgrounds including Cubans, Puerto Ricans, and South Americans that contrasts to the Mexican Hispanic majority in other US states. As there are no prior population-based studies examining ES in Florida, the role of racial/ethnic disparities on outcomes among this diverse patient population remains unknown. By utilizing the Florida Cancer Data System (FCDS) for ES patients, this study will assess overall racial/ethnic disparities, evaluate the impact of racial/ethnic disparities on OS, and compare ES incidence rates in Florida with national SEER-21 rates to assess risk. Methods: This retrospective secondary analysis examined all patients diagnosed with ES (2005-2018) in Florida (n = 411) and SEER-21 (n = 1,513). Age-adjusted incidence (AAI) with 95% confidence interval (95%CI) was analyzed for the entire group and OS was estimated using Kaplan-Meier survival analysis. Univariable and multivariable analyses using Cox regression models were performed for variables of interest—race/ethnicity, age, sex, year of diagnosis, site of disease, staging, SES, and insurance type. Adjusted hazard ratio (aHR) with 95%CI were calculated. Results: Per the FCDS, there was a higher incidence of ES in Hispanic males (AAI 2.6; 95%CI: 2.0-3.2 per 1,000,000; n = 84) as compared to the SEER (1.2; 1.1-1.4; n = 250). Among non-metastatic ES, Hispanics had an increased risk for cancer-related mortality compared to Non-Hispanic Whites (aHR 2.9; 95%CI: 1.46-5.74; p =0.002), after adjusting for all other variables. In the full model (all cases regardless of stage at diagnosis), older age and distant metastasis were statistically significant factors for poor OS while SES and insurance status were not. Conclusions: Hispanics in Florida are of interest for ES with a higher-than-expected incidence compared to the US and remarkably worse survival for non-metastatic disease compared to Non-Hispanic Whites. Further in-depth studies are needed to examine why this disparity exists, but it is potentially multifactorial. This is the first known study for ES health disparities in Florida and provides updated national data for comparison.